Pharm 3 - Unit 3: Adrenergic/adrenergic blocking agents & cholinergic

Adrenergics “Add 0.7 mm pens”

• Albuterol (Proventil, Ventolin)

• Dobutamine (Dobutrex)

• Dopamine (Intropin)

• Epinephrine (Adrenalin)

• Midodrine (Promatine)

• Mitabegron (Myrbetriq)

• Norepinephrine (Levophed)

• Phenylephrine (Neo-synephrine)

Adrenergic Antagonist (Adrengic-Blockers)

• Alpha Blockers:

  • Tamsulosin (Flomax)

  • Phentolamine

• Beta Blockers

  • Carvedilol (Coreg)

  • Metoprolol (Lopressor, Toprol XL)

  • Propranolol (Inderal)

Cholinergics

• Bethanechol (Urecholine)

• Donepezil (Aricept)

• Pyridostigmine (Mestinon) 

Cholinergic Blockers

• Atropine

• Dicyclomine (Bentyl)

• Oxybutynin (Ditropan) 

• Scopolamine 

• Tolterodine (Detrol)

• Other: Memantine (Namenda) 

Tamsulosin (Flomax)

• Alpha 1 Blocker

• Uses: BPH and urinary retention

  • Relaxes smooth muscles

Phentolamine

• Alpha 1 antagonist

• Control BP during surgery

• Treat and prevent skin injury from norepinephrine

• Diagnose pheochromocytoma

• IV route

• nurs. indications: measure BP, plasma, insulin and glucose levels before and after administration

• high levels of catecholamines med will cause a diagnosis

Beta-Blockers

• Antagonists of beta-adrenergic receptors and are commonly used in cardiovascular conditions like HTN, angina, arrhythmias, to reduce heart rate and blood pressure

• Selective: heart

• Non- selective: Heart and Lungs

What are contraindications of BB?

• Cardionergic shock, heart blocks, bradycardia, severe pulmonary disease, pregnancy

Adverse effects of BB?

• Hyper/hypoglycemia

• bradycardia

• depression

• constipation

• fatigues

• increased triglycerides

What are some interactions of BB?

• Antacids

• Digoxin

• Diuretics

• Alcohol

• Oral hypoglycemics

• BLACK BOX WARNING

Carvedilol (Coreg)

• non-selective beta blocker with alpha blocking properties

• Immediate and ER

• nursing: HF tx, monitor HR and BP before administration

Metoprolol (Lopressor/ Toprolol XL)

• Selective beta-1 receptor blocker

• Most commonly used to due cardioselectivity and does not work on lungs

• Forms: Oral and IV *high alert

• Monitor HR and BP

Propranolol

• Non-selective beta blocker

• Atrial fibrillation and ventricular arrhythmias

• Forms: Oral and IV

• Monitor BP and HR

BB Basic facts

Indications

• HTN, BPH, Raynaud’s, Frost bite

Contraindications

• PUD, Hepatic and renal disease

• CAD, Sepsis

Adverse Effects

• First dose phenomenon

• Orthostatic Hypotension

• Dizziness

• HA

• Constipation

• HTN

• Anxiety

• Dry mouth

Interactions

• Anti- HTN, Lidocaine/Digoxin, NSAIDs, Alcohol, Erectile dysfunction drugs, warfarin

Albuterol

• Beta 2

• Aerosol, tablet, ER, syrup, nebulizer

• Bronchodilator

• Decrease the effectiveness of BB and increase HR

Dobutamine

• Beta 1

• IV continuous infusion

• Cardiac Stimulant (works by increasing contractility and raising the HR

  • heart failure patients

Epinephrine

• Alpha and Beta

• Alpha: vasoconstriction

• Beta 1: contractility

• Beta 2: bronchodilation. asthma and anaphylaxis

• watch for different concentrations!

Midodrine

• Alpha - vasocontractions

• prior dialysis and orthostatic hypotension

• Watch administration times

  • give 4 hrs prior to bedtime, can keep patient up

Mirabegron

• Beta 3

• Relaxes the bladder detrusor muscle - given for overactive bladder

• AE: HTN, HA, UTIs

  • Angioedema

• Cannot crush or chew!

Norepinephrine

• Alpha 1

  • Can be Beta 1

• Hypotension and shock

• IV central line ONLY continuous infusion

  • natural vesicant and can cause severe tissue damage - blistering

Phenylephrine

• Alpha 1 - vasoconstriction

• Pupil dilation and nasal decongestant

  • Caution in people with HTN

• Do not use for longer than 3 days can cause rebound decongestion

Dopamine

• Alpha 1, Beta 1, dopaminergic (improve Parkinson’s symptoms and increase urinary output by enhancing renal perfusion)

• Continuous IV infusion

  • Low dose: increase blood flow

  • Medium dose: cardiac contractility

  • High Dose: vasocontraction

• Contraindicated in pheochromocytoma can cause arrythmias